I am still reeling from Stephanie Saul’s series on twins and multiple births from the October 11th issue of The New York Times. There is so much to say about all of it – and it keeps coming down to one thing: we still have a systems failure in how we supply treatment to infertile couples in the United States.
If not a systems failure, how else could you explain the couple’s profiled in “Grievous Choice on Risky Path to Parenthood”?
The stories of couple’s being encouraged or forced to do intrauterine insemination’s (IUI’s) because of finances and insurance coverage restrictions could filled volumes of books. Intrauterine insemination’s is how Jon and Kate got six little babies to get their eight. In a typical IUI cycle, women take injectable fertility medications to stimulate their egg production. Once the multiple eggs are mature, the woman is triggered with another medication to ovulate and then they are inseminated with sperm. I call IUI the “Russian Roulette of Fertility Treatments”, because the doctor is not in control of how many eggs will fertilize.
Somehow, a great myth was created about the IUI: that it was cheaper and less invasive than in vitro-fertilization. I did six IUI cycles with fertility medications, and I can tell you from first hand experience that it is not much easier than doing an IVF cycle. It’s really about the medications and the monitoring where most of the discomfort and time is put for the woman.
Whether you are doing an IUI cycle or an IVF cycle you are taking injectable medications which means that the woman is subjecting herself to needles, blood tests, sonograms and all of the joys of medication induced hormonal mood swings. The only difference for the patient is that with IVF she experiences retrieval of her eggs, and the transfer of her embryos which is easy in comparison to the rest of it.
Encouraging a patient to do intrauterine inseminations when Micro-IVF or standard IVF is available is sending patient’s back to the dark ages. We can do so much better than that today without the high risk of multiple births. The cost difference between a typical IUI cycle and a Micro IVF cycle is nominal. A typical IUI cycle can run between $2, 000- $4,000 and a Micro IVF cycle comes in just under $4,000. IUI’s have a lower success rate than IVF and a much higher multiple birth rate which add millions to our national health care budget.
So what is going on? Do we really need to read one more story about couples burying babies because they couldn’t survive a multiple birth pregnancy? Do we really need to suffer along with another couple as they make the gut wrenching decision about reduction? Do you really want to see images of tiny coffins? Who is steering this ship?
When are the insurance companies going to stop forcing infertile couples to do three IUI cycles before proceeding on to IVF or only offering coverage for intrauterine inseminations? When are they going to look at the real cost of IUI and see that Micro IVF or Standard IVF is a much better financial solution that is not only going to save lives and hearts but help create healthy families?
Reproductive medicine is in so many ways in a systems failure because of the lack of appropriate insurance coverage for patients, and it’s own market driven economy created out of the lack of insurance coverage and measurement tools such as The Wyden Bill.
Doctors are not looking across the country as they could be at lower stimulation IVF otherwise known as “Mini-IVF”, “Micro-IVF” or “Minimal Stimulation IVF” because it has a lower success rate than standard IVF and is reported in exactly the same way as standard IVF to SART and the CDC lowering their marketability to potential cash paying patients.
Single Embryo Transfer (SET) is mostly all talk and no action at most IVF Centers around the country because of the costs involved. The instinct in IVF Centers is to pass the costs onto the patients instead of restructuring how patients receive and pay for what they know to be the most appropriate care for some patients.
Reproductive Medicine is a rich field in comparison to other fields of medicine. Isn’t it possible for IVF Centers to simply make less money and still do very well?
Once again, I say it is time to restructure “business as usual” at IVF Centers around the country. According to Dr. Dave Kreiner, one of the doctors that have been around since the almost beginning of modern day Reproductive Endocrinology and Infertility, “Single Embryo Transfer is affordable by transferring one embryo at a time by offering free cryopreservation, free embryo storage and free embryo transfers until a patient achieves a live birth, all for the cost of a single IVF cycle.
IVF needs to be insured, and the use of fertility medications in an uncontrolled IUI cycle deeply curtailed. It’s time to put our Society For Assisted Reproductive Technology (SART) recommendations into law taking into account factors such as age, embryo quality and past experience.
We must discourage the use of gonadotropins without IVF by offering IVF as a regulated covered alternative. Until then, all of us including society are to blame for letting these dangerous multiple pregnancies occur”.